This review article gives an overview of the current state of the art of bladder cancer imaging and then discusses in depth the scientific and technical merit of a novel imaging approach, tracing its evolution from murine cancer models to cancer patients. While the poor resolution of soft tissue obtained by widely available imaging options such as abdominal sonography and radiation-based CT leaves them only suitable for measuring the gross tumor volume and bladder wall thickening, dynamic contrast-enhanced magnetic resolution imaging (DCE MRI) is demonstrably superior in resolving muscle invasion. However, major barriers still exist in its adoption. Instead of injection for DCE-MRI, intravesical contrast-enhanced MRI (ICE-MRI) instills Gadolinium chelate (Gadobutrol) together with trace amounts of superparamagnetic agents for measurement of tumor volume, depth, and aggressiveness. ICE-MRI leverages leaky tight junctions to accelerate passive paracellular diffusion of Gadobutrol (604.71 Daltons) by treading the paracellular ingress pathway of fluorescein sodium and of mitomycin (<400 Daltons) into bladder tumor. The soaring cost of diagnosis and care of bladder cancer could be mitigated by reducing the use of expensive operating room resources with a potential non-surgical imaging option for cancer surveillance, thereby reducing over-diagnosis and over-treatment and increasing organ preservation.

Background Bedside electrical impedance tomography could be useful to visualize evolving pulmonary perfusion distributions when acute respiratory distress syndrome worsens or in response to ventilatory and positional therapies. In experimental acute respiratory distress syndrome, this study evaluated the agreement of electrical impedance tomography and dynamic contrast–enhanced computed tomography perfusion distributions at two injury time points and in response to increased positive end-expiratory pressure (PEEP) and prone position. Methods Eleven mechanically ventilated (VT 8 ml · kg−1) Yorkshire pigs (five male, six female) received bronchial hydrochloric acid (3.5 ml · kg−1) to invoke lung injury. Electrical impedance tomography and computed tomography perfusion images were obtained at 2 h (early injury) and 24 h (late injury) after injury in supine position with PEEP 5 and 10 cm H2O. In eight animals, electrical impedance tomography and computed tomography perfusion imaging were also conducted in the prone position. Electrical impedance tomography perfusion (QEIT) and computed tomography perfusion (QCT) values (as percentages of image total) were compared in eight vertical regions across injury stages, levels of PEEP, and body positions using mixed-effects linear regression. The primary outcome was agreement between QEIT and QCT, defined using limits of agreement and Pearson correlation coefficient. Results Pao2/Fio2 decreased over the course of the experiment (healthy to early injury, −253 [95% CI, −317 to −189]; early to late injury, −88 [95% CI, −151 to −24]). The limits of agreement between QEIT and QCT were −4.66% and 4.73% for the middle 50% quantile of average regional perfusion, and the correlation coefficient was 0.88 (95% CI, 0.86 to 0.90]; P < 0.001). Electrical impedance tomography and computed tomography showed similar perfusion redistributions over injury stages and in response to increased PEEP. QEIT redistributions after positional therapy underestimated QCT in ventral regions and overestimated QCT in dorsal regions. Conclusions Electrical impedance tomography closely approximated computed tomography perfusion measures in experimental acute respiratory distress syndrome, in the supine position, over injury progression and with increased PEEP. Further validation is needed to determine the accuracy of electrical impedance tomography in measuring perfusion redistributions after positional changes. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

BACKGROUND:Lesion segmentation is a critical step in medical image analysis, and methods to identify pathology without time-intensive manual labeling of data are of utmost importance during a pandemic and in resource-constrained healthcare settings. Here, we describe a method for fully automated segmentation and quantification of pathological COVID-19 lung tissue on chest Computed Tomography (CT) scans without the need for manually segmented training data. METHODS:We trained a cycle-consistent generative adversarial network (CycleGAN) to convert images of COVID-19 scans into their generated healthy equivalents. Subtraction of the generated healthy images from their corresponding original CT scans yielded maps of pathological tissue, without background lung parenchyma, fissures, airways, or vessels. We then used these maps to construct three-dimensional lesion segmentations. Using a validation dataset, Dice scores were computed for our lesion segmentations and other published segmentation networks using ground truth segmentations reviewed by radiologists. RESULTS:The COVID-to-Healthy generator eliminated high Hounsfield unit (HU) voxels within pulmonary lesions and replaced them with lower HU voxels. The generator did not distort normal anatomy such as vessels, airways, or fissures. The generated healthy images had higher gas content (2.45 ± 0.93 vs 3.01 ± 0.84 L, P < 0.001) and lower tissue density (1.27 ± 0.40 vs 0.73 ± 0.29 Kg, P < 0.001) than their corresponding original COVID-19 images, and they were not significantly different from those of the healthy images (P < 0.001). Using the validation dataset, lesion segmentations scored an average Dice score of 55.9, comparable to other weakly supervised networks that do require manual segmentations. CONCLUSION:Our CycleGAN model successfully segmented pulmonary lesions in mild and severe COVID-19 cases. Our model's performance was comparable to other published models; however, our model is unique in its ability to segment lesions without the need for manual segmentations.

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Interstitial Cystitis (PD01)1 Sep 2021PD01-05 PROBING THE BLADDER WALL DIFFUSION OF INSTILLED GADOBUTROL BY MRI Pradeep Tyagi, Chan-Hong Moon, Nishant Singh, Marc Connell, Jodi Maranchie, Christopher Chermansky, Naoki Yoshimura, and Jonathan Kaufman Pradeep TyagiPradeep Tyagi More articles by this author , Chan-Hong MoonChan-Hong Moon More articles by this author , Nishant SinghNishant Singh More articles by this author , Marc ConnellMarc Connell More articles by this author , Jodi MaranchieJodi Maranchie More articles by this author , Christopher ChermanskyChristopher Chermansky More articles by this author , Naoki YoshimuraNaoki Yoshimura More articles by this author , and Jonathan KaufmanJonathan Kaufman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001965.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intravesical therapy is critical for bladder cancer and a secondary option for interstitial cystitis and overactive bladder patient's refractory to oral treatment. Although paracellular diffusion of instilled drugs and radioactive agents from urine is suggested by ultrastructural studies and studies on diffusion across the excised whole bladder wall in Ussing chamber, the kinetics of diffusion across just the thickness of bladder mucosa is yet to be probed directly in a radiation-free manner with a non-invasive, non-tissue destructive method. Since MRI is capable of imaging the microscopic dimensions of bladder mucosa (Am J Physiol Renal Physiol 2020;319(3): F506-F514.), we investigated the diffusion kinetics of instilled Gadobutrol in a phantom constructed with 12% polyacrylamide (PLGA) gel, whose nanometer sized pores can partly mimic the nanometer gap of the apico-lateral tight junctions in mammalian urothelium. METHODS: PLGA gel was poured into a plastic jar while embedding 9 glass tubes which were removed upon setting of gel to create 9 cylindrical cavities for instilling ascending concentrations [0.5-20 mM] of Gadobutrol together with a fixed concentration of Ferumoxytol 0.1 mM. Phantom was wrapped by a 4 channel-flexible receiver coil for imaging in 3T scanner (Siemens, BioGraph) using T2 weighted Half-Fourier Acquisition Single-shot Turbo spin Echo imaging (HASTE) (repetition time 1000-1300 ms/echo time 80-90 ms). Gel diffusion of Gadobutrol was assessed by imaging at 30 min and at 5 h. RESULTS: The bright ring around the cavities demonstrates that molecular size of 0.8 nm permits easy diffusion of Gadobutrol into the >40 times bigger pores of 12% PLGA gel. The concentration gradient is the driving force for Gadobutrol diffusion is supported by the dependence of ring brightness on Gadobutrol concentration [0.5-20 mM] at room temperature and on the expansion of dark blob at 5 h in cavities filled with Gadobutrol 5-20 mM to recapitulate the classical pseudolayering effect of Gadobutrol accumulating into stored urine of bladder. CONCLUSIONS: MR imaging validated the linear relationship between Gadobutrol concentration in cavity and the signal gain in the surrounding gel, a surrogate for bladder mucosa. Findings support that MRI at clinical scanner can reliably assess the mucosal diffusion of instilled drugs and probes in bladder permeability assay. Source of Funding: DK 108397;CA252590 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e32-e32 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pradeep Tyagi More articles by this author Chan-Hong Moon More articles by this author Nishant Singh More articles by this author Marc Connell More articles by this author Jodi Maranchie More articles by this author Christopher Chermansky More articles by this author Naoki Yoshimura More articles by this author Jonathan Kaufman More articles by this author Expand All Advertisement Loading ...

You have accessJournal of UrologyImaging/Radiology: Uroradiology II (MP22)1 Sep 2021MP22-01 HIGH RESOLUTION 3D T1-MAPPING OF PIG BLADDER WALL BY INTRAVESICAL CONTRAST ENHANCED MRI AT 3T Pradeep Tyagi, Chan-Hong Moon, Nishant Singh, Marc Connell, Jodi Maranchie, Christopher Chermansky, Naoki Yoshimura, and Jonathan Kaufman Pradeep TyagiPradeep Tyagi More articles by this author , Chan-Hong MoonChan-Hong Moon More articles by this author , Nishant SinghNishant Singh More articles by this author , Marc ConnellMarc Connell More articles by this author , Jodi MaranchieJodi Maranchie More articles by this author , Christopher ChermanskyChristopher Chermansky More articles by this author , Naoki YoshimuraNaoki Yoshimura More articles by this author , and Jonathan KaufmanJonathan Kaufman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002013.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We previously reported on the single slice T1 mapping of human bladder using a pair of spoiled gradient recalled echo (SPGR) images acquired at different flip angles. Here, we used pig bladder to develop a three-dimensional, multi-slice imaging protocol for voxel-wise T1 mapping of mucosal enhancement after instilling Gadobutrol and Ferumoxytol mixture. METHODS: Freshly harvested pig bladders (n=10) were preserved in ice-cold Krebs Buffer and then instilled with either 40mL of same buffer (pre-contrast) or Millipore water containing ascending concentrations of Gadobutrol [4-80 mM] and Ferumoxytol [0.1-30 mM] (post-contrast imaging). Bladder placed in jar was wrapped around with four channel flexible receiver coil for volumetric coverage with 2mm slice thickness in voxel size 0.7×0.7×2.0 mm using Qfat suppressed 3D SPGR acquisition in cartesian trajectory. Repetition time/ echo time (TR/TE) 5.5/2.4 ms, variable flip angle 3°-25° and total acquisition time of 1:15 min. RESULTS: Instillation of Gadobutrol as a mixture with Ferumoxytol precludes Gadobutrol mediated signal enhancement in rat bladder lumen via rapid signal dephasing in spin echo images. However, clinically used gradient echo pulse sequences accentuates the phase aliasing from the luminal presence of Ferumoxytol [>0.1mM] and Gadobutrol [>20mM] mixture due to a dramatic increase in the inhomogeneities of static magnetic field around bladder wall and the susceptibility-related distortion in the phase-encoding direction limits the geometric accuracy of bladder wall anatomy. Acquisition of high-resolution images devoid of susceptibility artifacts, that is, signal drop and distortion can be accomplished after instillation of Gadobutrol 20mM mixed with Ferumoxytol 0.1mM (Fig.1), where pig bladder wall is visually segmented into an inner thin layer of high intensity, a middle layer of lower signal and a darker outer layer and color coded voxel wise T1 maps. CONCLUSIONS: Findings display a real-time acquisition and display of the whole bladder, color -coded T1 maps at 3T for first time. A freshly mixed instillation of Gadobutrol together Ferumoxytol visually segments the bladder wall into three layers for potential applications in staging of bladder tumors and the phenotyping bladder-centric manifestation of IC/BPS. Source of Funding: DK 108397;CA252590 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e390-e390 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pradeep Tyagi More articles by this author Chan-Hong Moon More articles by this author Nishant Singh More articles by this author Marc Connell More articles by this author Jodi Maranchie More articles by this author Christopher Chermansky More articles by this author Naoki Yoshimura More articles by this author Jonathan Kaufman More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: Prone ventilation redistributes lung inflation along the gravitational axis; however, localized, nongravitational effects of body position are less well characterized. The authors hypothesize that positional inflation improvements follow both gravitational and nongravitational distributions. This study is a nonoverlapping reanalysis of previously published large animal data. Methods: Five intubated, mechanically ventilated pigs were imaged before and after lung injury by tracheal injection of hydrochloric acid (2 ml/kg). Computed tomography scans were performed at 5 and 10 cm H2O positive end-expiratory pressure (PEEP) in both prone and supine positions. All paired prone-supine images were digitally aligned to each other. Each unit of lung tissue was assigned to three clusters (K-means) according to positional changes of its density and dimensions. The regional cluster distribution was analyzed. Units of tissue displaying lung recruitment were mapped. Results: We characterized three tissue clusters on computed tomography: deflation (increased tissue density and contraction), limited response (stable density and volume), and reinflation (decreased density and expansion). The respective clusters occupied (mean +/- SD including all studied conditions) 29.3 +/- 12.9%, 47.6 +/- 11.4%, and 23.1 +/- 8.3% of total lung mass, with similar distributions before and after lung injury. Reinflation was slightly greater at higher PEEP after injury. Larger proportions of the reinflation cluster were contained in the dorsalversusventral (86.4 +/- 8.5%vs. 13.6 +/- 8.5%,P< 0.001) and in the caudalversuscranial (63.4 +/- 11.2%vs. 36.6 +/- 11.2%,P< 0.001) regions of the lung. After injury, prone positioning recruited 64.5 +/- 36.7 g of tissue (11.4 +/- 6.7% of total lung mass) at lower PEEP, and 49.9 +/- 12.9 g (8.9 +/- 2.8% of total mass) at higher PEEP; more than 59.0% of this recruitment was caudal. Conclusions: During mechanical ventilation, lung reinflation and recruitment by the prone positioning were primarily localized in the dorso-caudal lung. The local effects of positioning in this lung region may determine its clinical efficacy.

Background VSL#3 is a patented probiotic for which several clinical trials suggest benefits on motor function, bloating, and symptoms of irritable bowel syndrome (IBS). Objectives Methods To quantify effects of VSL#3 on abdominal pain, stool consistency, overall response, abdominal bloating, and quality of life (QOL) in IBS through meta-analysis. MEDLINE (OvidSP and PubMed), EMBASE, Web of Science, and Scopus were searched up to May 2017. Using a fixed effects model, we pooled data from intention-to-treat analyses of randomized trials (RCTs) comparing VSL#3 to placebo in IBS. Data were reported as relative risk (RR), overall mean difference (MD), or standardized MD (SMD) with 95% confidence intervals (CI). Quality of evidence was rated using the GRADE approach. Key Results Conclusions & Inferences Among 236 citations, 5 RCTs (243 patients) were included. No significant differences were observed for abdominal pain (SMD = -0.03; 95% CI -0.29 to 0.22), bloating (SMD = -0.15; 95% CI -0.40 to 0.11), proportion of bowel movements with normal consistency (overall MD = 0; 95% CI -0.09 to 0.08), or IBS-QOL (SMD = 0.08; 95% CI -0.22 to 0.39). VSL#3 was associated with a nearly statistically significant increase in overall response (RR = 1.39; 95% CI 0.99-1.98). In this systematic review and meta-analysis, there was a trend toward improvement in overall response with VSL#3, but no clear evidence effectiveness for IBS. However, the number and sample sizes of the trials are small and the overall quality of evidence for 3 of the 5 outcomes was low. Larger trials evaluating validated endpoints in well-defined IBS patients are warranted.

AIM:To assess the feasibility of radiation dose reduction with adaptive iterative dose reduction (AIDR-6 3D) reconstruction in dynamic pulmonary CT perfusion. MATERIALS AND METHODS:CTP examinations of 10 patients acquired at 100 kVp/50 mAs were reconstructed with filtered back projection (FBP) and AIDR-3D. Artificial noise was added to raw data (pre-reconstruction projection data) to simulate lower tube current scanning. Radiodensity (in Hounsfield units), noise, and perfusion values were compared. RESULTS:There was no significant difference in noise between the full and simulated reduced tube current with AIDR-3D reconstruction (p = 1). There was significantly lower noise in lung tissue with AIDR-3D images when compared to reconstructions without AIDR-3D (p = 0.005) and no significant change in the radiodensity (p = 1; mean difference <6 HU). Mean perfusion values increased significantly at lower tube currents (25 and 12.5 mAs), compared to 50 mAs (p = 0.005). This effect was significantly greater in larger patients compared to thin patients. CONCLUSION:AIDR-3D produced significantly lower noise images than FBP-based algorithms and maintained consistent noise levels in lung at 12.5 mAs, indicating this algorithm is suitable for reduced dose lung perfusion imaging. Iterative reconstruction allows significant radiation dose reduction of up to fourfold in smaller patients, and up to twofold in the medium/large size patients. The increase in perfusion values at 25% simulated tube currents is attributed to attenuation bias.